Using 1998 data, we have estimated persons with mental disorders in U.S. nursing homes may now total approximately 1,000,000, or 67% of all residents. Jakubiak and Callahan (1995-96) note that, "More than two-thirds of nursing home residents exhibit some level of dementia, depression, anxiety, schizophrenia, or delirium." High quality, error free nursing home care is time and labor-intensive and vital to optimizing residents' mental and physical health, but the current nursing shortage will escalate as the Baby Boomers age and require substantially more care. In the proposed project, we will examine possible associations between nurse staffing and mental health outcomes in approximately 17,000 U.S. nursing homes. We will focus on two outcomes available in the Center for Medicare and Medicaid Services' On-line Survey Certification of Automated Records: (1) Psychoactive medication use; and (2) Deficiencies for mental health care. Mental disorders are quite prevalent in nursing homes and present a substantial illness burden. Additionally, quality issues around inappropriate use of chemical restraints, inappropriate treatment, and failure to diagnose mental disorders are errors that generate concern among nursing home residents, their families, nursing home staff, and the public. The insights possible through this research support a key component of NIMH's research plan to: "Determine the best fit and utility of treatment and prevention interventions for diverse populations," including the elderly population and to: "Determine the impact of organization and financing of services on outcomes." The specific objectives are to: (1) Describe nursing staffing levels in U.S. nursing homes; (2) describe the mix of nursing staff in U.S. nursing homes; (3) assess possible associations between nursing home staffing and mental health-related quality outcomes and deficiencies (including those persisting over time); (4) assess possible associations between nursing home staff mix and mental health-related quality outcomes and deficiencies (including those persisting overtime); and (5) inform policies related to nurse staffing that aim to enhance mental health outcomes. We will generate simple descriptive statistics related to the level and mix of nursing staff, mental health-related quality outcomes and deficiencies, and basic environmental and market characteristics for each nursing home. Then, we will examine the cross-sectional relationship between (1) mental health-related quality outcomes and deficiencies and (2) facility and market factors (especially nurse staffing levels and mix). Because studies of small area variation show that environmental factors have a strong impact upon the health care system and can affect process and outcome variables such as psychotropic medication use and code violations, we will include them in our analysis. [unreadable] [unreadable]